896 Evaluation of an Active, Population-Based Surveillance System for Candidemia in Georgia

Sunday, March 21, 2010
Grand Hall (Hyatt Regency Atlanta)
Monika Roy, MD , Centers for Disease Control, Atlanta, GA
Angela Ahlquist, MPH , Centers for Disease Control, Atlanta, GA
Monica M. Farley, MD , Emory University, Atlanta, GA
Wendy Baughman, MSPH , Atlanta VA Medical Center, Atlanta, GA
Betsy Siegel, RN, BSN , Emory University, Atlanta, GA
Shawn R. Lockhart, PhD , Centers for Disease Control, Atlanta, GA
Tom Chiller, MD, MPH , Centers for Disease Control, Atlanta, GA
Benjamin J. Park, MD , Centers for Disease Control, Atlanta, GA
Background: Candida spp. are the fourth most-common cause of hospital-associated bloodstream infections, associated with a 40% attributable mortality and a 30-day increase in hospital stay. Active population-based surveillance for candidemia through CDC’s Emerging Infections Program (EIP) began in metropolitan Atlanta and Baltimore in 2008. Preliminary data show that candidemia incidence and resistance are increasing compared to past reports. 

Objective: To evaluate the quality, sensitivity, and representativeness of the data obtained in the Georgia candidemia surveillance system.  

Methods: Key characteristics of the surveillance system were determined by interviewing surveillance coordinators and officers at the Georgia EIP site. Preliminary data collected by the surveillance system were analyzed to determine overall sensitivity in case reporting and isolate receipt at CDC for speciation and antifungal susceptibility testing. To assess the representativeness of the cases with matched isolates, we analyzed case characteristics and Candida species distribution using descriptive statistics and Chi-square analysis to compare the case population with and without isolates. 

Results: Of 819 total candidemia cases collected in Georgia from March 1, 2008 to September 1, 2009, 70% were initially reported by hospital laboratories, with the remainder later identified through monthly laboratory audit; 66% of isolates were submitted to CDC. Several case characteristics, including death at discharge, intensive care unit stay, presence of a central venous catheter, and Candida species were not statistically different between cases with or without an isolate submitted to CDC. Identification of the case by audit was significantly associated with a missing isolate submission (p<0.001).  

Conclusions: In this surveillance system, monthly auditing improved the overall sensitivity of candidemia case identification, but did not increase isolate submission. However, submitted isolates are likely representative of the overall population. Lessons learned from this analysis may be applied to other hospital-based surveillance networks.